FAQs on Infertility from Malpani Infertility Clinic.

Q. My husband and I have an active sex life, we are both healthy, and my periods are regular. However, we have still not conceived ! Please help !
A. You need to remember that it's not possible to determine the reason for your infertility until you undergo tests to find out if your husband's sperm count is normal; if your fallopian tubes and uterus are normal; and if you are producing eggs. Only after undergoing these tests will your doctor be able to tell you why you are not conceiving. While testing does cause considerable anxiety, it's far better to intelligently identify the problem so that we can look for the best solution.

Q. How can I determine my "fertile" period ?
A. Your fertile period is the time during which having sex could lead to a pregnancy. This is the 4-6 days prior to ovulation ( release of a mature egg from the ovary). Women normally ovulate 14 days prior to the date of the next menstrual period. If you are mathematically challenged, you can use this free online ovulation calendar .

Q. My gynecologist has done an internal examination and said I am normal. Do I still need to get tests done to determine why I am not conceiving ?
A. A routine gynecological examination does not provide information about possible problems which can cause infertility, such as blocked fallopian tubes or ovulatory disorders. You need a systematic infertility workup.

Q. Do painful periods cause infertility ?
A. Painful periods do not affect fertility. In fact, for most patients, regular painful periods usually signal ovulatory cycles. However, progressively worsening pain during periods (especially when this is accompanied by pain during sex) may mean you have endometriosis.

Q. My periods come only once every 6 weeks. Could this be a reason for my infertility ?
A. As long as the periods are regular, this means ovulation is occurring. Some normal women have menstrual cycle lengths of as long as 40 days. Of course, since they have fewer cycles every year, the number of times they are "fertile" in a year is decreased. Also, they need to monitor their fertile period more closely, since this is delayed (as compared to women with a 30 day cycle).

Q. My husband's blood group is B positive and I am A negative. Could this blood group "incompatibility" be a reason for our infertility ?
A. There is no relation between blood groups and fertility.

Q. After having sex, most of the semen leaks out of my vagin. How can we prevent this ? Should we change our sexual technique ? Could this be a reason for our infertility ?
A. Loss of seminal fluid after intercourse is perfectly normal, and most women notice some discharge immediately after sex. Many infertile couples imagine that this is the cause of their problem. If your husband ejaculates inside you, then you can be sure that no matter how much semen leaks out afterwards, enough sperm will reach the cervical mucus. This leakage of semen ( which is called effluvium seminis) is not a cause of infertility. In fact, this leakage is a good sign - it means your husband is depositing his semen normally in your vagina. Of course, you cannot see what goes in - you can only see what leaks out - but the fact that some is leaking out means enough is going in!

Q. My colleagues at work tell me that if we "work" hard at getting pregnant, and want it enough, we definitely will ! In fact, my mother in law is even suggesting that the fact that I am not conceiving means that subconsciously I do not wish to have a baby ( because it may interfere with my career) and that this psychological barrier is the reason for our infertility.
A. Unlike many other parts of your lives, infertility may be beyond your control. Don't blame yourself if you are not getting pregnant - it's a medical problem which often needs appropriate medical treatment. The attitudes you are encountering are often born out of ignorance - and are a kind of "victim-blaming" - ignore them !

Q. My grandmother says that if I just pray and have faith, I will definitely conceive. How far is this true ?
A. Believing in god can help you to maintain a positive outlook - but sheer will and blind faith won't overcome a physical problem like blocked tubes or absent sperms.

Q. My husband refuses to get his semen tested. He says the fact that it is thick and voluminous means it must be normal.
A. Semen consists mainly of seminal fluid, secreted by the seminal vesicles and the prostate. The volume and consistency of the semen is not related to its fertility potential, which depends upon the sperm count. This can only be assessed by microscopic examination.

Q. My sister conceived only after 6 years of marriage. Does this mean I will also have difficulty conceiving ?
A. If your mother, grandmother or sister has had difficulty becoming pregnant, this does not necessarily mean you will have the same problem! Most infertility problems are not hereditary, and you need a complete evaluation.

Q. My doctor just did a physical examination for me, and he feels that the reason for my infertility is that my uterus is tipped backwards, and this prevents the sperm from swimming into the uterus. He is advising I have surgery to correct this problem. Should I go ahead ?
A. About one in five women will have a retroverted uterus. If the uterus is freely mobile, this is normal, and is not a cause of infertility. This is not an indication for surgery!

Q. My husband says we should be having intercourse every day to achieve pregnancy. Is this true ?
A. Sperm remain alive and active in woman's cervical mucus for 48-72 hours following sexual intercourse; therefore, it isn't necessary to plan your lovemaking on a rigid schedule.

Q. My friends say I should have sex exactly on the day I ovulate to get pregnant. How can I do this ?
A. Although having sexual intercourse near the time of ovulation is important, no single day is critical. So, don't be concerned if intercourse is not possible or practical on the day of ovulation.

Q. My sister in law is advising me to keep a pillow under my hips during and after intercourse . Will this increase my chances of conceiving ?
A. Sperm are already swimming in cervical mucus as sexual intercourse is completed and will continue to travel up the cervix to the fallopian tube for the next 48 to 72 hours. The position of the hips really doesn't matter.

Q. My mother feels I am too tense, and that if I just relax, I'll get pregnant.
A. If pregnancy has not occurred after a year, chances are there is a medical condition causing infertility. There is no evidence that stress causes infertility. Remember, all infertile patients are under stress - it's not the stress which causes infertiliity, it's the infertility which causes the stress!

Q. I just had a HSG ( X-ray of the uterus and tubes) done, and this shows my tubes are blocked. I've never had symptoms of a pelvic infection, so how could my tubes get blocked ?
A. Many pelvic infections have no symptoms at all, but can cause damage, sometimes irreversibly, to the tubes.

Q. My doctor has advised me to take fertility drugs . I don't want to take them because if I am scared that if I do, then I'll have a multiple births.
A. Fact: Although fertility drugs do increase the chance of having a multiple pregnancy (because they stimulate the ovaries to produce several eggs), the majority of women taking them have singleton births.

Q. My husband's sperm count varies every time we test it ! How do we determine what the "real" sperm count is ?
A. Even a normal ( fertile ) man's sperm count can vary considerably from week to week. Sperm count and motility can be affected by many factors, including time between ejaculations, illness, and medications. There are other factors which affect the sperm count as well, all of which we do not understand.

Q. I have no problems having sex. Since I am virile, my sperm count must be normal.
A. There is no correlation between male fertility and virility. Men with totally normal sex drives may have no sperms at all.

Q. All my tests are normal, and yet I can't get pregnant. My doctor says my infertility is "unexplained" ! What does this mean ? The very fact that I cannot conceive means there must be something wrong !

A. Yes, you are right. Unexplained infertility is simply a confession of our ignorance, and means that our technology is not good enough to be able to identify the problem. For example, a semen analysis can show that your sperm count is normal. However, it tells us nothing about the functional competence of the sperm - whether they are able to fertilise the egg or not ! In any case, I feel the question should NOT be "Why am I not getting pregnant ? " Rather, it should be - What can I do in order to get pregnant ?" After all, no one cares about problems - we only care about results - about having a baby ! Fortunately, our technology for solving problems ( by bypassing them in the IVF lab !) is much better than our technology for identifying them - and perhaps this is just as well !T his means that rather than waste time trying to pinpoint the problem, we can just bypass it altogether !

Q. Even though I have health insurance, my insurance policy will not cover infertility treatment ! Isn't this
unfair ?

A. Yes, it is. However, the situation will not change until you ( and other infertile patients ) do something about it ! After all, an insurance company is a profit-making business enterprise, and it's in their best interests to exclude as many diseases as they can, as their only focus is their bottom-line ! The good news is that patients can lobby to get this to change. This can be a slow process, and you need to fight for your rights ! This has been done successfully by infertility support groups in some States in the US ( where it is now compulsory for insurance companies to cover IVF treatment).  If you work in a large corporate, you can put pressure on your HRD department,  and request them to insist that their insurance policy provider covers IVF treatment. You can learn how to write an Advocacy Letter here.

Q. My semen analysis report shows I have no sperm in the semen ( azoospermia ). Is this because I used to masturbate excessively as a boy ?
A. Masturbation is a normal activity which most boys and men indulge in. It does not affect the sperm count. You cannot "run" out of sperms, because these are constantly being produced in the testes.

Q. My wife is frigid and does not enjoy having sex. Could this be the reason for her infertility?
A. There is no connection between sexual pleasure and fertility. Don't forget that even a woman who gets raped can get pregnant! And don't forget that the commonest reason women do not enjoy sex is because their husbands are unskilled lovers ! Maybe you should improve your sexual technique, and spend more time in foreplay and in pleasuring your wife.

Q. How long do I need to be in India if I need to come to your clinic for IVF treatment ?
A. You would need to spend about 20 days in India, starting from Day 1 of your cycle. You need to come to the clinic for only 4- 7 visits. From Day 4 - Day 9, you can even visit the Taj or Ajanta-Ellora; or go to Kerala for an ayurvedic massage to de-stress yourself. Go ahead and explore India - it's a completely different world ! This means you can have an incredible holiday as well. Check out www.incredibleindia.org for more ideas. If your local doctor agrees, you can start your meds in your hometown and come directly on Day 10, which means you would have to spend only about 10 days in Bombay. Hotel rooms cost about US $ 50 per night in India.

Q. Do you offer a shared-risk program ?
A. Yes, we do. You can read about our "money-back" option here.

Q. Can I talk to any of your patients ?
A. Yes, you can. Some of our patients have kindly agreed to act as "email buddies" and will be happy to talk to you by email. You can read their stories and contact them through our website page here.

Q. Where were you trained ?
A. We completed our MD in Obstetrics and Gynecology from India's premier medical college, KEM Hospital in Bombay University. We are extremely familiar with the US medical system, because we have trained at Johns Hopkins Medical School and Harvard Medical School. We have received advanced training in IVF at King's College Hospital, London; and the University of California at San Francisco.

Q. Can you help with travel, tickets and hotel accommodation ?
A.  Many travel agents in India now have their own websites, and they will be happy to help you out. You can find a list at  http://www.indiatourism.com/travelagents/mumbai-travel-agents.html. Shop around for the best deal ! You can also select a hotel close to the clinic at www.drmalpani.com/hotels.htm ! 

Q. Do I have to get any tests/blood work done by my gynecologist before we start the procedure?
A. We need the results of the following simple medical tests before starting an IVF cycle.

1. semen analysis for your husband
2. blood tests for you for the following reproductive hormones - FSH ( follicle-stimulating hormone),LH ( luteinising hormone),PRL ( prolactin) and TSH ( thyroid stimulating hormone) on Day 3 of your cycle, ( to check the quality of your eggs);
3. a HSG ( hysterosalpingogram, X-ray of the uterus and tubes) on Day 8 of your cycle ( to confirm your uterine cavity is normal);
4. a vaginal ultrasound scan on Day 10-13 of your cycle, to confirm your uterus is normal.

If the tests have been done in the past one year, there is no need to repeat them. If there is a problem, then we can treat it prior to starting IVF !

Q. Can I bring the medications from US, if my insurance provider covers the costs for it?
A. Yes.

Q. Could you recommend a place for us to stay that is close to your clinic?
A. There is a list of hotels at www.drmalpani.com/hotels.htm

Q. How frequently should we visit your clinic during the IVF treatment cycle ?
A. About 7 visits - on Day 1,3,10,12,14,16 and 18

Q. How much does it cost for freezing the embryos ?
A. US $ 1500 . This includes storage for 1 year

Q. If a cycle of IVF fails, what should be the time gap that needs to be given before we try again ?
A. You can cycle back to back if you so desire.

Q. If I decide to stay there until we confirm the pregnancy with an ultrasound, Is it safe for me to fly back after that during my first trimester?
A. Yes, this is fine too.

Do you need more information on infertility ? Our book, Getting Pregnant - A Guide for the Infertile Couple, is a very valuable resource - and the full book is available online, free of charge!

Do you have a question you'd like answered ? Please Ask-the-Doctor.